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Objectives
To systematically review the descriptors used to define running-related musculoskeletal injury and to analyse the implications of different definitions on the results of studies.

Background
Studies have developed their own definitions of running-related musculoskeletal injuries based on different criteria. This may affect the rates of injury, which can be overestimated or underestimated due to the lack of a standard definition.

Methods
Searches were conducted on EMBASE, PubMed, CINAHL, SPORTDiscus, LILACS and SCIELO databases, without a limit to date of publication and language. We only included articles that reported a definition of running-related injury. The definitions were classified according to three domains and subcategories: 1) presence of physical complaint (symptom, body system involved, region); 2) interruption of training or competition (primary sports involved, extent of injury, extent of limitation, interruption, period of injury); and 3) need for medical assistance. Spearman rank correlation was performed to verify the correlation between the completeness of definitions and the rates of injury reported in the studies.

Results
A total of 48 articles were included. Most studies described more than half of the subcategories, but with no standardisation between the terms used within each category, showing that there is no consensus for this definition. The injury rates ranged between 3% and 85%, and tend to increase with less-specific definitions.

Conclusion
The descriptors commonly used by researchers to define an injury vary between studies and may affect the rates of injuries. The lack of a standardised definition hinders comparison between studies and rates of injuries.

Objective
To reach a consensus definition of running-related injury in recreational runners through a modified Delphi approach.

Background
Many studies have suggested the need for a standardised definition of running-related injury to provide uniformity to injury surveillance in running.

Methods
We invited 112 running researchers identified in a previous systematic review were asked to classify words and terms frequently used in definitions of running-related injury through an online form during three rounds of study. In the last round, they were asked to approve or disapprove the consensus definition. We considered an agreement level of at least 75% to be a consensus.

Results
Thirty-eight participants agreed to participate in the study. The response rates were 94.7% (n=36) for the first round, 83.3% (n=30) for the second round and 86.7% (n=26) for the third round. A consensus definition of running-related injury was reached, with 80% of participants approving the following: “Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration or training) for at least seven days or three consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional”.

Conclusion
The proposed standardised definition of running-related injury could assist in standardizing the definitions used in sport science research and facilitate between-study comparisons. Future studies testing the validity of the proposed consensus definition, as well as its accurate translation to other languages, are also needed.

What are the Differences in Injury Proportions Between Different Populations of Runners? A Systematic Review and Meta-Analysis
Bas Kluitenberg , Marienke van Middelkoop, Ron Diercks and Henk van der WorpSports Medicine; 2015

Background
Many runners suffer from injuries. No information on high-risk populations is available so far though.
Objectives
The aims of this study were to systematically review injury proportions in different populations of runners and to compare injury locations between these populations.
Data Sources
An electronic search with no date restrictions was conducted up to February 2014 in the PubMed, Embase, SPORTDiscus and Web of Science databases. The search was limited to original articles written in English. The reference lists of the included articles were checked for potentially relevant studies.
Study Eligibility Criteria
Studies were eligible when the proportion of running injuries was reported and the participants belonged to one or more homogeneous populations of runners that were clearly described. Study selection was conducted by two independent reviewers, and disagreements were resolved in a consensus meeting.
Study Appraisal and Synthesis Methods
Details of the study design, population of runners, sample size, injury definition, method of injury assessment, number of injuries and injury locations were extracted from the articles. The risk of bias was assessed with a scale consisting of eight items, which was specifically developed for studies focusing on musculoskeletal complaints.
Results
A total of 86 articles were included in this review. Where possible, injury proportions were pooled for each identified population of runners, using a random-effects model. Injury proportions were affected by injury definitions and durations of follow-up. Large differences between populations existed. The number of medical-attention injuries during an event was small for most populations of runners, except for ultra-marathon runners, in which the pooled estimate was 65.6 %. Time-loss injury proportions between different populations of runners ranged from 3.2 % in cross-country runners to 84.9 % in novice runners. Overall, the proportions were highest among short-distance track runners and ultra-marathon runners.
Limitations
The results were pooled by stratification of studies according to the population, injury definition and follow-up/recall period; however, heterogeneity was high.
Conclusions
Large differences in injury proportions between different populations of runners existed. Injury proportions were affected by the duration of follow-up. A U-shaped pattern between the running distance and the time-loss injury proportion seemed to exist. Future prospective studies of injury surveillance are highly recommended to take running exposure and censoring into account.

Objectives
Despite several consensus statements, different injury definitions are used in the literature. This study aimed to identify the impact of different injury definitions on the nature and incidence of complaints captured during a short-term running program for novice runners.

Design
Prospective cohort study.

Methods
1,696 participants completed weekly diaries on running exposure and musculoskeletal complaints during a 6-week running program. These data were used to compare six different injury definitions (presence of running-related pain, training-reduction, time-loss of one day or one week). Injuries were registered under these different definitions. Consequently incidence and the nature of complaints were compared between definitions.

Results
The different injury definitions resulted in incidences that varied between 7.5% and 58.0%, or 18.7 and 239.6 injuries per 1,000 hours of running. The median duration of injury complaints was 4 to 7 days for injuries registered under a ‘day definition’, while complaints registered under a ‘week definition’ lasted 20 to 22 days. For running-related pain injuries the median of the maximum amount of pain was 3.0. In training-reduction and time-loss injuries these median values were scored between 5.0 and 7.0. No significant differences in anatomical locations between injuries that were registered under a ‘day definition’ or a ‘week definition’ were found. Injuries registered under a time-loss definition were located relatively more often at the knee, while complaints at the pelvis/sacrum/buttock were captured more often under a running-related pain definition.

PURPOSE: It is well-known that runners are commonly injured, yet rates of
running injuries reported in the literature vary widely, ranging from 19% to 92%.
This discrepancy in reported injury rates may be due to several factors, including
injury definition, the timeline used when reporting injuries, and whether the reporting
method is self-report or reported by medical professionals. Therefore, the purpose
of this study was to compare self-reported injury rates to medically-reported injury
rates in a group of Division-I cross country runners. METHODS: Questionnaires
regarding pain, injury, and training status were completed at the beginning and end
of the 2015 and 2016 seasons. Additionally, injury reports were obtained from the
team’s certified athletic trainer (ATC). Data were coded as 1) self-reported only; 2)
ATC-reported only; 3) self-reported and ATC-reported. Only injuries that occurred
within the past year were considered in the analysis. RESULTS: In 2015, 12 athletes
participated, with 38 reported injuries. Of those, 26 were self-reported (68.4%), 6
were ATC-reported (15.8%), and 6 were both self-reported and ATC-reported (15.8%).
In 2016, 9 athletes participated, with 22 reported injuries. Of those, 13 were selfreported
(59.1%), 8 were ATC-reported (36.4%), and 1 was both self-reported and
ATC-reported (4.5%). Additionally, about half of the reported injuries (47% in 2015;
55% in 2016) led to missed or modified training. Of those injuries that led to missed
or modified training, the majority (88% in 2015 and 91% in 2016) were self-reported
only. CONCLUSIONS: The results indicate a marked difference in self-reported
injury rates compared with medically-reported injury rates. This demonstrates that the
method of reporting injuries may be a contributing factor to the wide range of reported
injuries in the literature. Thus, caution should be taken when considering injury rates
reported in the literature, as the method of reporting injuries may be influential.

This study examined the criterion validity of self-reported running-related injuries (RRI) by novice runners. Fifty-eight participants (41 females; age 46 ± 11 yrs) of the "Start-to-Run" program provided self-reports on their RRIs using an online questionnaire. Subsequently, they attended injury consultations with sports medicine physicians who provided physician-reports (blinded for the self-reports) as a reference standard. Self-reports and physician-reports included information on injury location (i.e., hip/groin, upper leg, knee, lower leg, and ankle/foot) and injury type (i.e., muscle-tendon unit, joint, ligament, or bone). Sensitivity, specificity, and positive predictive values were 100% for all five injury locations. For injury type, sensitivity was low (66% for muscle-tendon unit, 50% for ligament, and 40% for bone) and lowest for joint injuries (17%). In conclusion, the validity of self-reported RRIs by novice runners is good for injury locations but not for injury types. In particular for joint injuries, the validity of novice runners' self-reports is low.